Predictive Value of CHA2DS2-VASc Score in Patients with Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction.

Abstract

Objective: Contrast-induced nephropathy (CIN) is one of the well-known complications of cardiac catheterization and related with in-hospital and long-term morbidity and mortality. We aimed to evaluate if CHA2DS2-VASc score can also be used as a surrogate for CIN development and moreover the relationship between CIN development and in-hospital major adverse cardiac events (MACE) in patients presenting with STEMI and undergoing primary PCI.

Methods: All patients presented with STEMI and underwent primary PCI between 2015-2019 in our center were included retrospectively.

Results: A total of 572 patients were included. Age [P = 0.032, β: 0.153, odds ratio (95% CI): 0.014-0.302], diabetes mellitus [(P = 0.023, β: 0.134, odds ratio (95% CI): 0.017-0.217], history of stroke [P = 0.034, β: 0.118, OR (95% CI): 0.017-0.436], volume of contrast medium [P = 0.042, β: 0.155, OR (95% CI): 0.109-0.462], left ventricular ejection fraction [P = 0.003, β: 0.376, OR (95% CI): 0.214-0.517], and CHA2DS2-VASc score [P = 0.001, β: 0.115, OR (95% CI): 0.054-0.177] were detected as independent risk factors associated with contrast-induced nephropathy development. The area under the curve for CHA2DS2-VASc score was 0.809 (95% CI: 0.760-0.857). A cut-off value of 2.5 for CHA2DS2-VASc score was associated with 80.1% sensitivity and 71.4% specificity in the prediction of contrast-induced nephropathy development.

Conclusion: Our current study showed that the CHA2DS2-VASc risk score has an effective discriminating power in determining the contrast-induced nephropathy development and a score ≥2 defines the group at risk in patients presenting with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention. Moreover, contrast-induced nephropathy development is associated with longer coronary care unit stay and major adverse cardiac events (in-hospital decompensated heart failure, cardiogenic shock, cardiac arrest, and mortality).